I think anyone who deals with patients with wounds will agree that selecting the right wound dressings and bandages is crucial to wound healing. It may also be the most challenging part of wound management! With so many choices in wound dressings and bandages, it’s easy to become confused.
To simplify matters, there are a few questions you can ask yourself to narrow down your choices when making a decision regarding wound dressings and bandages:
- Is the wound wet or dry? If the wound in question is dry, you might choose a dressing that will donate moisture, such as a hydrogel dressing. If the wound bed is too moist or the wound is highly exudative, you will want to choose a dressing that will absorb excess moisture, such as an alginate dressing.
- Is there slough or necrotic tissue present? If the wound bed is granulating and there is no slough, eschar or necrotic tissue present, all that is needed is to protect the fragile wound bed and maintain a moist, normothermic environment. A transparent film dressing or a simple gauze dressing may suffice. However, if the wound has necrotic tissue present, you may need to choose a dressing that encourages autolytic debridement, such as a semipermeable foam dressing, a hydrocolloid or an alginate dressing, depending on the amount of wound drainage.
- Are there signs or symptoms of infection? If the wound is infected, you might choose a dressing that has been impregnated with silver or iodine to decrease the wound’s bioburden. These dressings vary greatly in their ability to absorb wound exudate, so amount of wound drainage is another factor that you will need to take into consideration.
- Is odor a major concern? When odor is a major concern for the patient, such as in wounds resulting from a fungating cancer or an infected pressure ulcer, you may consider using a charcoal dressing. These dressings work by absorbing the odor-producing gases that are emitted by bacteria.
These are just a few of the considerations that you must take into account when choosing a dressing. Cost, ease of use and level of comfort must also be considered and may influence your choice of wound dressings and bandages.
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I think one of the difficult things for nurses to do is decide on which wound care product is appropriate for a wound. Some nurses don’t come into contact with major wounds often enough to feel comfortable to make that decision. I think having a wound resource nurse available is a good solution to helping nurses become comfortable with making wound care decisions.
Thank you, Laurie! I concur. With so many dressings in the market it is critical to know which are appropriate in each individual case. From a marketing perspective, being familiar with the features and benefits of the products available along with knowing the integrity and trust you can have in the manufacturer behind them, certainly aids in the decision. Your key questions help simplify a most challenging part of the decision-making process!
Which published guidelines and best practices do you recommend for nurses?
Wounds UK publishes many wound related guidelines and WoundSource has great product information. The Canadian Association of wound care also publishes best practice articles.
If nurses learn dressing categories, i.e. hydrogels, foams, hydrocolloids, calcium alginates, collagen, etc, what each dressing category treats, it will be much easier to choise the right product. What would help immensely, would be for manufacturers to label dressings according to standard categories. It’s crazy when this is not indicated, and chosing the wrong dressing, equalms poor outcome, equals deficient practice. Make a list of all dressings in each category (from your formulary, or approved dressings in your facility), as a reference, cheat sheet, educational tool, & you will empower your nurses to do the right thing.